Question Easy: A 56-year-old woman presents to the GP with fatigue, weight gain, and cold intolerance. On examination, her skin is dry and she has bradycardia. What is the most likely diagnosis? 🕵️♀️
A) Hyperthyroidism
B) Addison’s disease
C) Hypothyroidism
D) Cushing’s syndrome
E) Pheochromocytoma
Question Medium: A 32-year-old man presents with headaches, sweating, and palpitations. His blood pressure is persistently elevated, and a 24-hour urine collection shows elevated catecholamines. What is the most appropriate next step in management? 🚑
A) CT scan of the abdomen
B) MRI of the brain
C) Plasma renin and aldosterone measurement
D) 24-hour serum cortisol measurement
E) Beta-blocker therapy
Question Hard: A 45-year-old woman presents with recent memory loss, muscle twitching, and difficulty walking. She has recently had exposure to undercooked beef while traveling. MRI shows hyperintense signals in the basal ganglia. What is the most likely diagnosis? 🧠
A) Alzheimer’s disease
B) Creutzfeldt-Jakob disease
C) Multiple sclerosis
D) Parkinson’s disease
E) Huntington’s disease
Explanations & Answers:
Question Easy Answer: C) Hypothyroidism
Question Easy Explanation: The symptoms of fatigue, weight gain, cold intolerance, dry skin, and bradycardia are classic for hypothyroidism. According to NICE guidelines, primary hypothyroidism should be suspected with such clinical presentations, and confirmed with high TSH and low free T4 levels.
Question Medium Answer: A) CT scan of the abdomen
Question Medium Explanation: This patient presents with symptoms suggestive of pheochromocytoma, a catecholamine-secreting tumor. The elevated catecholamines in the urine support this diagnosis. The next step is imaging of the adrenal glands, typically with a CT scan, to locate the tumor, as recommended by NICE guidelines.
Question Hard Answer: B) Creutzfeldt-Jakob disease
Question Hard Explanation: The patient’s symptoms of recent memory loss, muscle twitching, and gait difficulties, coupled with a history of undercooked beef consumption and the MRI findings, suggest Creutzfeldt-Jakob disease, a rare and fatal prion disease. NHS guidelines indicate that MRI findings of hyperintensities in the basal ganglia are characteristic of this condition.
Medical fact of the day: Did you know that the thyroid gland is the only endocrine gland in the body that stores its hormones extracellularly? In the UK, hypothyroidism is commonly diagnosed and managed in primary care with levothyroxine.
Quote of the day: “In the face of illness, let your empathy be the light that shines, guiding both patient and healer towards the path of hope and recovery.”